New therapy helps victims of Alexia

WASHINGTON - An experimental therapy is helping people with a bewildering condition called alexia, which can leave its victims speaking normally and able to spell words aloud but unable to read.

A stroke left Bill seeing written letters that looked like gibberish — devastating to an educated 62-year-old left terrified of getting lost amid street signs he couldn't decipher.

The condition occurs when damage from a stroke or other head injury severs a crucial connection in the complex brain system required for reading.

"We're getting information about the shape of the letter into the part of the brain that knows that shape," but in a different way, explains Georgetown University neurology professor Rhonda Friedman, who is leading the experiment funded by the National Institutes of Health.

It's too early to know how well the technique works, although Friedman and co-researcher Susan Lott report that a handful of patients so far, some who hadn't recognized letters in years, have mastered menus, signs and other everyday reading tasks.

"What good is a person who can't read one letter?" says Bill, who asked that his last name not be used as he described more than a year of frustration and embarrassment coping with alexia.

It was more difficult, he says, than relearning to walk. Doctors had few suggestions; $160-an-hour speech-pathology sessions failed.

Most bizarre, Bill could write meaningful sentences, but he couldn't read what he'd written down. The bridge linking his vision to the brain region that stored memories of those letters was gone.

Then his doctor heard about Friedman's experiment, a simple-sounding strategy despite the name "tactile-kinesthetic reading": First, patients are taught the correct way to write letters. Then, using a capped pen in one hand, they trace letters one at a time onto the palm of the other hand until they can read a word letter-by-letter.

The theory holds that the technique trains brain cells to retrieve letter memories via another sense than vision, similar to how children sometimes are taught by tracing letters in sand.

After about six months of therapy, Bill can read some words and phrases, more and more with practice.

"I couldn't tell an A from an O, and now I can read, now I can do things on my own," he says with a grin.

It is unknown how often alexia, sometimes called "acquired dyslexia," occurs. One major study suggests that 19 percent of elderly stroke survivors suffer some type of language difficulty involving either verbal or written communication, or both, six months after the brain attack.

"Disorders of reading are very common following stroke," says Louis Quatrano of the NIH's National Center for Medical Rehabilitation Research. Because stroke survivors often have so many other, more visible disabilities, however, "It is probably an overlooked or underserved group," Quatrano said.

"A lot of these patients get lost," agrees Georgetown's Friedman. "The doctors say, `Oh, they can't read; that's not so bad.'"

Complicating matters, alexia comes in bafflingly different forms. Unlike Bill's pure alexia, people with so-called partial alexias recognize letters but can read only certain types of words. They may read concrete nouns such as "inn," as in hotel, but cannot decipher more abstract words such as the preposition "in." Or they may interpret only words spelled like they sound, understanding "winter" but not "thought."

It depends on exactly where the brain was injured. And understanding the conditions may provide a better window into how the brain processes language and learns to read in the first place, Quatrano says.

Scientists have tried different approaches for each alexia type. For example, some teach patients automatically to match a vague word with a concrete one, to trigger recognition.

But there's little data on how well the approaches work. Friedman's NIH-funded experiment aims to change that, matching different therapies to different alexias, along with some MRI scans to see if patients' brain connections really change.